Advocacy Agenda Shifts With SGR Behind Us

Last week, I attended the Family Medicine Congressional Conference (FMCC) in Washington, and for the first time in 17 years, we did not have to lobby legislators and congressional staff about the Medicare sustainable growth rate (SGR) formula.

We did thank legislators who voted overwhelmingly to repeal the fatally flawed SGR. Now we're moving into a post-SGR world. This doesn’t mean everything is fixed, but it does allow us to focus our energies and our voices on addressing other much-needed changes in our health care system, including payment reform, graduate medical education reform and truly valuing primary care.

Here I am meeting with Sen. Sheldon
Whitehouse, D-R.I., (center) along with members of our Rhode Island delegation: Roanne
Osborne-Gaskins, M.D., Keith Callahan, M.D., (second from right) and resident Jason Kahn, M.D. (far right). Hundreds
of family physicians met with legislators and congressional staff last week
during the Family Medicine Congressional Conference.

FMCC is an inspiring event. I looked around the room and saw remarkable people who I have “grown up with” during six years on the AAFP Board of Directors, including three as an officer. It has been rewarding to see family physicians who I installed as state chapter presidents developing as leaders.

These meetings also affirm one of the core attributes of family medicine -- it really is about relationships. Attending an Academy meeting is like coming to a family reunion. The biggest frustration for me is not having enough time to spend with all the people with whom I wish to catch up. (So, if I didn’t get to you this time, I’m sorry and I look forward to our next meeting!)

FMCC has a different focus than other occasions when AAFP officers are on Capitol Hill advocating for our specialty. The Academy staff does an incredible job providing information to chapter leaders and creating opportunities for legislators to address critical topics.

I was honored that my own congressman, Rep. Phil Roe, M.D., R-Tenn., came to speak at one of the plenary sessions. Although he’s an OB-Gyn, he told stories just like we all do to make his points. He’s excited about moving away from the contentious SGR debates and toward new issues. He has appreciated that near the end of the SGR process, physicians learned to speak with one voice and more clearly about health care reform. He understands the value of primary care, and, in the words of one of our attendees, “He gets it.” More and more of our legislators are getting the message about primary care, and its important role in our health care system. They are beginning to understand that the term “primary care physician” is best associated with the specialty of family medicine, and that we need to make many more changes to link value to this recognition.

At FMCC, we addressed the fact that legislation and regulations need to value primary care in practical and immediate ways. For example, we need to push to remove co-pays from chronic care management fees to remove the hurdle that patients and family physicians face in obtaining and providing needed chronic care coordination, and in accessing primary care.

We need to be sure that the definition of primary care is clearly understood, especially when medical schools are still touting, sometimes in a misleading manner, high graduation rates of primary care physicians. We need to make sure that when people are praising primary care, and vowing to value it, that we’re all on the same page in this regard, and the foundational component of family medicine as the primary care specialty is understood.

Although we are pleased that the National Health Service Corps and the Teaching Health Center Graduate Medical Education program have been funded for two more years, we need to continue to push for these vital programs to be recognized as the successes stories they are. Although they were extended by the same legislation that repealed the SGR, they should be permanently removed from the budgetary chopping block.

GME reform was emphasized as a vital issue during last week's event. We’re challenging legislators to look at ways of increasing transparency regarding GME funding and demanding accountability for the $13 billion put into the medical education system each year. The current system is not producing the workforce we need despite the tremendous investment.

It was refreshing to see things come together regarding the way that families and communities care for each other. FMCC featured a plenary about family caregiving. One of our requests of the legislators we met with was that they join the recently formed Assisting Caregivers Today caucus(www.washingtonpost.com). This effort creates an opportunity for many stakeholders to work together to find ways to care for people outside of hospitals. In so many ways, this echoes our call for people to receive right care in the right place at the right time from the right person. Ultimately, the best answer for providing this care is through team and community-based care.

Finally, I was honored to join our state chapter leaders during visits with their state legislators and congressional staffers. I was incredibly impressed with the Oregon chapter’s discussions with staff members of Sen. Ron Wyden, D-Ore., the ranking democratic member of the Senate Finance Committee. Melissa Hemphill, M.D., who is just two years out of residency, took the lead during this meeting, and she did as good a job as any AAFP officer or other veteran advocates in articulating our perspectives.

I also joined the Rhode Island delegation for a meeting with Sen. Sheldon Whitehouse, D-R.I. He impressed me with his understanding of medical issues, especially as they related to his state. Roannne Osborne-Gaskin, M.D., and Keith Callahan, M.D., clearly expressed the challenges they face in their practice settings in that state. I was impressed with the good work that our state leaders are doing.

It's worth noting that FMCC came right on the heels of the Academy's Annual Chapter Leader Forum, which offers training in areas such as advocacy, communication and more. The process of leadership development and relying on the informed voices of state leaders is such a key aspect of making change. As an Academy, we continue to advocate for our patients and practices.

There is still much work to be done, but I see several doors opening that had been closed for so long. Thanks for all you do, and keep up the great work.

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